Posterior lamellar keratoplasty using descemetorhexis and organ-cultured donor corneal tissue (Melles technique)

Purpose: To report the clinical results of posterior lamellar keratoplasty (PLK) using predissected organ-cultured donor corneal tissue implanted after stripping of the Descemet membrane. Methods: Twenty-two eyes of 22 patients in whom a PLK procedure was performed for pseudophakic bullous keratopathy and/or Fuchs endothelial dystrophy were evaluated. In all eyes, the recipient Descemet membrane was excised by performing a descemetorhexis. Just after harvesting the donor tissue, each cornea had a posterior lamellar dissection made at approximately 80% stromal depth, and each cornea was preserved in an organ culture system for 10 to 21 days. During surgery, a posterior lamellar disk was trephinated from the predissected donor cornea and inserted through a 5.0-mm scleral incision into the anterior chamber of the recipient by folding the donor. Specular microscopy was performed at 6, 12, and 18 months to measure the endothelial cell density. Results: In 3 eyes (14%), the posterior donor disk did not attach to the recipient posterior stroma, so a penetrating keratoplasty was performed in a secondary procedure. The transplants in the remaining 19 eyes cleared and maintained clarity throughout the follow-up period. In these eyes, best corrected visual acuity (BCVA) ranged from 0.25 to 1.0 up to 27 months of follow-up. Postoperative astigmatism averaged 1.7 +/- 1.0 D. Endothelial cell density averaged 1650 +/- 390 cells/mm(2) at 6 months, 1560 +/- 350 cells/mm(2) at 12 months, and 1500 +/- 430 cells/mm(2) at 24 months. Two eyes developed mild interface haze. Conclusion: PLK can be performed using an organ-cultured donor posterior disk. Visual rehabilitation may be slower than in PLK with fresh donor tissue.